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Management and outcome of high-order multiple pregnancy

Published online by Cambridge University Press:  15 January 2010

Shlomo Lipitz
Affiliation:
Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Dan Grisaru
Affiliation:
Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Zeev Rotstein
Affiliation:
Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Reuwen Achiron
Affiliation:
Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Israel.

Extract

The incidence of pregnancies with three or more fetuses has markedly increased over the past two decades. The change has been attributed to the introduction and widespread use of new techniques for ovulation induction and placement of multiple embryos during in vitro fertilization (IVF). These techniques have been a matter of concern, since triplet and higher multiple pregnancies have long been associated with an increased risk of maternal complications, and a high prevalence of perinatal and neonatal morbidity and mortality. Furthermore, the developing experience with multifetal pregnancy reduction offers a new option for the management of these pregnancies. There is therefore a need to evaluate the management and outcome of high-order multiple pregnancies.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1996

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References

1Elster, AD, Bleyl, JL, Craven, TE. Birth weight standards for triplets under modern obstetric care in the United States, 1984–1989. Obstet Gynecol 1991; 77: 387–93.Google Scholar
2Rein, MS, Babieri, RL, Greene, MF. The causes of high-order multiple gestation. Int J Fértil 1990; 35: 154–56.Google ScholarPubMed
3Levene, MI, Wild, J, Steer, P. Higher multiple births and the modern management of infertility in Britain. Br J Obstet Gynaecol 1992; 99 607–13.CrossRefGoogle ScholarPubMed
4Gonen, R, Heyman, E, Asztalos, EV, Ohlsson, A, Pitson, LC, Shennan, AT. The outcome of triplet, quadruplet and quintuplet pregfnancies managed in a perinatal unit: obstetric neonatal and followup data. Am J Obstet Gynecol 1990; 162: 454–59.CrossRefGoogle Scholar
5Ron-el, R, Caspi, E, Schreyer, P, Weintraub, Z, Arieli, S, Goldberg, MD et al. Triplet and quadruplet pregnancies and management. Obstet Gynecol 1981; 57: 458–63.Google ScholarPubMed
6Holchberg, G, Biale, Y, Lewenthal, H, Insler, V. Outcome of pregnancy in 31 triplet gestations. Obstet Gynecol 1982; 59: 472–76.Google Scholar
7Loucopoulos, A, Jewelewicz, R. Management of multifetal pregnancies: sixteen years experience at the Sloane Hospital for Women. Am J Obstet Gynecol 1982; 143 902905.CrossRefGoogle Scholar
8Deale, CJC, Cronje, HS. A review of 367 triplet pregnancies. S Afr Med J 1984; 66: 92–4.Google ScholarPubMed
9Petrikovsky, BM, Vintzeleos, AM. Management and outcome of multiple pregnancy of high fetal order: Literature review. Obstet Gynecol 1989; 44: 578–84.Google ScholarPubMed
10Lipitz, S, Reichman, B, Paret, G, Modan, M, Shalev, J, Serr, DM et al. The improving outcome of triplet pregnancies. Am J Obstet Gynecol 1989; 161: 1279–84.Google Scholar
11Lipitz, S, Frenkel, Y, Watts, C, Ben-Rafael, Z, Barkai, G, Reichman, B et al. High order multifetal gestation - management and out-come. Obstet Gynecol 1990; 76: 215–18.Google Scholar
12Kiely, JL, Kleinman, JC, Kiely, M. Triplets and higher-order multiple births. Am J Dis Child 1992; 146: 862.CrossRefGoogle ScholarPubMed
13Botting, BH, McDonald-Davies, I, McFarlane, AJ. Recent trends in the incidence of multiple births and associated mortality. Arch Dis Child 1987; 62: 941–50.CrossRefGoogle ScholarPubMed
14Neilson, JP, Crowther, CA. Preterm labour in multiple pregnancies. Fetal Matem Med Rev 1993; 5: 105–19.CrossRefGoogle Scholar
15Newman, RB, Homer, C, Miller, MC. Outpatient' triplet management: a contemporary review. Am J Obstet Gynecol 1989; 161: 547–55.Google Scholar
16Sassoon, DA, Castro, LC, Davis, JL, Bear, M, Hobel, CJ. Perinatal outcome in triplet versus twin gestations. Obstet Gynecol 1990; 75: 817–20.Google ScholarPubMed
17Daw, E. Triplet pregnancy. Br J Obstet Gynecol 1978; 85: 505509.CrossRefGoogle ScholarPubMed
18Syrop, CH, Varner, MW. Triplet gestation: maternal and neonatal implications. Acta Genet Med Gemellol (Roma) 1985; 34: 81–8.Google ScholarPubMed
19Persson, P, Grennert, L. Towards normalisation of outcome of twin pregnancy. Acta Genet Med Gemellol (Roma) 1979; 28: 341–46.Google Scholar
20Mou, SM, Sunderji, SG, Gall, S, How, H, Patel, V, Gray, M. Multicenter randomized clinical trial of home uterine activity monitoring for detection of preterm labor. Am J Obstet Gynecol 1991; 165 858–66.CrossRefGoogle ScholarPubMed
21Grimes, DA, Schultz, KF. Randomized controlled trials of home uterine monitoring: a review and critique. Obstet Gynaecol 1992; 79: 137–42.Google Scholar
22McLennan, AH, Green, RC, O'Shea, R et al. Routine hospital admission in twin pregnancy between 26 and 30 weeks gestation. Lancet 1990; 335: 267–69.Google Scholar
23Crowther, CA, Verkuyl, DAA, Neilson, JP, Bannerman, C, Ashurst, HM. The effects of hospitalization for rest on fetal growth, neonatal morbidity and length of gestation in twin pregnancy. Br J Obstet Gynaecol 1990; 97: 872–77.CrossRefGoogle ScholarPubMed
24Crowther, CA, Neilson, JP, Verkuyl, DAA, Bannerman, C, Ashurst, HM. Preterm labor in twin pregnancies: can it be prevented by hospital admission. Br J Obstet Gynaecol 1989; 96: 850–53.Google Scholar
25Crowther, CA, Verkuyl, DAA, Ashworth, M. The effects of hospitalization for bed rest on duration of gestation, fetal growth and neonatal morbidity in triplet pregnancy. Acta Genet Med Gemello (Roma) 1991; 40: 63–8.Google Scholar
26Keirse, MJNC. Prophylactic oral betamimetics in twin pregnancies. In: Chalmers, I ed, Oxford database of perinatal trials version 1.3. Disk Issue 7, Record 3462. Oxford: Oxford University Press, Spring 1992.Google Scholar
27Katz, M, Robertson, PA, Creasy, RK. Cardiovascular complications associated with terbutaline treatment for preterm labor. Am J Obstet Gynecol 1981; 139: 605608.Google Scholar
28Itzkowic, D. A survery of 59 triplet pregnancies. Br J Obstet Gynaecol 1979; 86: 23–8.Google Scholar
29Keirse, MJNC. Indomethacin tocolysis in preterm labor. In: Chalmers, I ed. Oxford database of perinatal trials Version 1.2. Disk Issue 4, Record 4383. Oxford: Oxford University Press, August 1990.Google Scholar
30Dor, J, Shalev, J, Mashiach, S, Blankstein, J, Serr, DM. Elective cervical suture of twin pregnancies diagnosed ultrasonically in the first trimester following induced ovulation. Gynecol Obstet Invest 1982; 13: 5560.Google Scholar
31MRC Cervical Cerclage Trial. MRC/RCOG Working Party on Cervical Cerclage. Interim report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists Multicentre Randomised Trial of Cervical Cerclage. Br J Obstet Gynaecol 1988; 95: 437–45.Google Scholar
32Grant, A. Cervical cerclage in twin pregnancy. In: Chalmers, I ed. Oxford database of perinatal trials Version 1.3. Disk Issue 8. Record 3280. Oxford: Oxford University Press, Autumn 1992.Google Scholar
33Mordel, N, Laufer, N, Zajicek, G, Dorembus, D, Benshushan, A, Schenker, JG et al. Menotropins as a possible risk factor for premature deliveries in triplet pregnancies. Gynecol Endocrinol 1991; 5: 197201.CrossRefGoogle ScholarPubMed
34Pons, JC, Mayenga, JM, Plu, G, Forman, RG, Papiernik, E. Management of triplet pregnancy. Acta Genet Med Gemellol (Roma) 1988: 37: 99103.Google ScholarPubMed
35Newman, RB, Jones, JS, Miller, MC. Influence of clinical variables on triplet birth weight. Acta Genet Med Gemellol (Roma) 1991; 40: 173–79.Google ScholarPubMed
36Seoud, MAF, Toner, JP, Kruithoff, C, Muasher, SJ. Outcome of twin, triplet and quadruplet in vitro pregnancies.: The Norfolk experience. Fertil Steril 1992; 57: 825–34.CrossRefGoogle ScholarPubMed
37Botting, B, MacFarlane, A, Price, AM. Triplet and higher order multiple births. The Sixth Report of the Interim Licensing Authority for Human In Vitro Fertilization and Embryology. 1991; 32–7.Google Scholar
38Lipitz, S, Seidman, DS, Alcalay, M, Achiron, R, Mashiach, S, Reichman, B. The effect of fertility drugs and in vitro methods on the outcome of 106 triplet pregnancies. Fértil Steril 1993; 60: 1031–34.Google Scholar
39Kingsland, CR, Steer, CV, Pampliglione, JS, Mason, BA, Edwards, RG, Campbell, S. Outcome of triplet pregnancies resulting from IVF at Bourn Hallam 1984–1987. Eur J Obstet Gynecol Rep Biol 1990; 34: 197203.CrossRefGoogle ScholarPubMed
40Rizk, B, Doyle, P, Tan, SL, Rainsbury, P, Betts, J, Brinsden, P et al. Perinatal outcome and congenital malformations in in vitro fertilization from babies from the Bourn Hallam Group. Hum Repród 1991; 6: 1259–64.CrossRefGoogle ScholarPubMed
41Berkowitz, RL, Lynch, L, Chitakara, U, Wilkins, LA, Mehalek, KE, Alvarez, E. Selective reduction of multifetal pregnancies in the first trimester. N Engt J Med 1988; 318: 1043–47.Google Scholar
42Wapner, RJ, Davis, G, Johnson, A, Weinblatt, VJ, Fischer, RL, Jackson, LG et al. Selective reduction in multifetal pregnancies. Lancet 1990; 335: 9093.CrossRefGoogle ScholarPubMed
43Evans, MI, Fletcher, JC, Zador, IE, Newton, BW, Quigg, MH, Struyk, GD et al. Selective first trimester termination in octoplet and quadruplet pregnancies: clinical and ethical issues. Obstet Gynecol 1988; 71: 289–96.Google ScholarPubMed
44Lynch, L, Berkowitz, RL, Chitkara, U, Alvarez, M. First trimester transabdominal multifetal pregnancy reduction: a report of 85 cases. Obstet Gynecol 1990; 75; 735–38.Google ScholarPubMed
45Boulot, P, Hedon, B, Pelliccia, G, Deschamps, F, Benos, P, Audibert, F et al. : Obstetrical results after embryonic reductions performed on 34 multiple pregnancies. Hum Repród 1990; 5: 1009–13.Google Scholar
46vans, MI, May, M, Drugan, A, Fletcher, JC, Johnson, MP, Sokol, RJ et al. Selective termination: clinical experience and residual risks. Am J Obstet Gynecol 1990; 162: 1568–75.CrossRefGoogle Scholar
47Dommergues, M, Nisand, I, Mandelbrot, L, Isfer, E, Radunovic, N, Dumez, Y. Embryo reduction in multifetal pregnancies after infertility therapy: obstetrical risks and perinatal benefits are related to operative strategy. Fertil Steril 1991; 55: 805–11.CrossRefGoogle ScholarPubMed
48Berkowitz, RL, Lynch, L, Lapinski, R, Bergh, P. First trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases. Am J Obstet Gynecol 1993; 169: 1721.Google Scholar
49Timor-Tritsch, IE, Reisner, DB, Monteagudo, A, Lerner, JP, Sharma, S. Multifetal pregnancy reduction by transvaginal puncture: evaluation of the technique used in 134 cases. Am J Obstet Gynecol 1993; 168: 799804.CrossRefGoogle ScholarPubMed
50Evans, MI, Dommergues, M, Wapner, RJ, Lynch, L, Dumez, Y, Goldberg, JD et al. Efficacy of transabdominal multifetal pregnancy reduction: collaborative experience among the world's largest centers. Obstet Gynecol 1993; 82: 6166.Google ScholarPubMed
51Evans, MI, Dommergues, M, Timor-Tritsch, I, Zador, IE, Wapner, RJ, Lynch, L et al. Transabdominal versus transcervical and transvaginal multifetal pregnancy reduction: international collaborative experience of more than one thousand cases. Am J Obstet Gynecol 1994; 170: 902909.CrossRefGoogle ScholarPubMed
52American College of Obstetrics and Gynecology. Multifetal pregnancy reduction and selective fetal termination. ACOG Committee Opinion 94, 1991.Google Scholar
53Melgar, CA, Rosenfeld, DL, Rawlinson, K, Greenberg, M. Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations. Obstet Gynecol 1991; 78: 763–66.Google Scholar
54Porreco, RP, Burke, MS, Hendrix, ML. Multiple reduction of triplets and pregnancy outcome. Obstet Gynecol 1991; 78: 335–39.Google Scholar
55Vauthier-Brouzes, D, Lefebvre, G. Selective reduction in multifetal pregnancies: technical and psychological aspects. Fértil Steril 1992; 57: 1012–16.CrossRefGoogle ScholarPubMed
56Shalev, J, Frenkel, Y, Goldenberg, M, Shalev, E.Lipitz, S, Barkai, G et al. Selective reduction in multiple gestations: pregnancy outcome after transvaginal and transabdominal needle-guided procedures. Fértil Steril 1989; 52: 416–20.Google Scholar
57Dickey, RP, Olar, TT, Curóle, DN, Taylor, SN, Rye, PH, Matulich, EM et al. The probability of multiple births when multiple gestational sacs or viable embryos are diagnosed at first trimester ultrasound. Hum Repród 1990; 5: 880–82.Google Scholar
58Itskovitz-Eldor, J, Drugan, A, Levron, J, Thler, I, Brandes, JM. Transvaginal embryo aspiration - a safe method for selective reduction in multiple pregnancies. Fértil Steril 1992; 58: 351–55.CrossRefGoogle ScholarPubMed
59Lipitz, S, Reichman, B, Uval, J, Shalev, J, Achiron, R, Barkai, G et al. A prospective comparison of the outcome of triplet pregnancies managed expectantly or by multifetal reduction to twins. Am J Obstet Gynecol 1994; 170 874–79.Google Scholar
60Tabsh, KM. Transabdominal multifetal pregnancy reduction: report of 40 cases. Obstet Gynecol 1990; 75: 739–41.Google Scholar
61Macones, GA, Schemmer, G, Pritts, E, Weinblatt, V, Wapner, RJ. Multifetal reduction of triplets to twins improves perinatal outcome. Am J Obstet Gynecol 1993; 169: 982–86.Google Scholar
62Lipitz, S, Yuval, Y, Achiron, R, Schiff, E, Lusky, A, Reichman, B. Comparison of the outcome of twin pregnancies reduced from triplets with non-reduced twin gestations. Obstet Gynecol (in press).Google Scholar
63Lowry, MP, Stafford, J. Northern region twin survey. J Obstet Gynecol 1988; 8: 228–34.CrossRefGoogle Scholar
64Taffel, SM. Health and demographic characteristics of twin births: United States, 1988. National Center for Health Statistics. Vital Health Stat 21 50: 1992.Google Scholar
65Garel, M, Blondel, B. Assessment at 1 year of the psychological consequences of having triplets. Human Repród 1992; 7: 729–32.Google Scholar
66Salat-Baroux, J, Aknin, JAntoine, JM, Alamowitch, R et al. The management of multiple pregnancies after induction for superovulation. Hum Repród 1988; 3: 399401.Google Scholar
67Itskovitz, J, Boldes, R, Thaler, I, Levron, J, Rottem, S, Brandes, JM. First trimester selective reduction in multiple pregnancy guided by transvaginal sonography. JCU 1990; 18: 323–27.Google ScholarPubMed
68Gonen, Y, Blankier, J, Casper, RF. Transvaginal ultrasound in selective embryo reduction for multiple pregnancy. Obstet Gynecol 1990; 75: 720–22.Google ScholarPubMed
69Lipitz, S, Yaron, Y, Shalev, J, Achiron, R, Zolti, M, Mashiach, S. Improved results in multifetal pregnancy reduction: a report of 72 cases. Fértil Steril 1994; 61: 5961.Google Scholar
70Blake, GD, Knuppel, RA, Ingardia, CJ, Lake, M, Aumann, G, Hanson, M. Evaluation of nonstress fetal heart rate testing in multiple gestations. Obstet Gynecol 1984; 63: 528–32.Google ScholarPubMed
71Alcalay, M, Lipitz, S, Ben-Rafael, Z, Barkai, G, Mashiach, S. Fetal biophysical profile score in triplet pregnancies. J Reprod Med 1994; 39: 436–40.Google Scholar
72Manning, FA, Morrison, MB, Hárman, CR, Menticoglou SM. The abnormal biophysical profile score. V. Predictive accuracy according to score composition. Am J Obstet Gynecol 1990; 162: 918–25.CrossRefGoogle ScholarPubMed
73Lodiero, JR, Vintzileos, AM, Freinstein, SJ, Campbell, WA, Nochimson, DJ. Fetal biophysical profile in twin gestations. Obstet Gynecol 1986; 67: 824–27.Google Scholar
74Giles, WB, Trudinger, BJ, Cook, CM. Umbilical waveforms in twin pregnancy. Acta Genet Med Gemellol (Roma) 1985; 34: 233–38.Google Scholar
75Gerson, AG, Wallace, BM, Bridgens, NK, Ashmead, GG, Weiner, S, Bolognese, RJ. Duplex Doppler ultrasound in the evaluation of growth in twin pregnancies. Obstet Gynecol 1987; 70: 419–23.Google ScholarPubMed
76Anderson, RL, Goldberg, SD, Golbus, MS. Prenatal diagnosis in multiple gestation: 20 year's experience with amniocentesis. Prenat Diagn 1991; 11: 263–70.CrossRefGoogle Scholar